The effects of epidural patient controlled bupivacaine levobupivacaine and ropivacaine followed by epidural morphine.

ABSTRACTThe effects of epidural patient controlled bupivacaine, levobupivacaine andropivacaine followed by epidural morphineThis prospective, double blind, randomized, controlled study was designed toevaluate the effectiveness and side effect of epidural patient controlled bupivacaine,levobupivacaine and ropivacaine followed by epidural 3 different doses of morphineor saline.Two hundred and fifty-seven ASA I-II parturients were recruited randomly toreceive patient controlled bupivacaine, levobupivacaine and ropivacaine forpostoperative pain relief. Each group was also divided into four subgroup dependingon morphine loading doses (0, 1, 2, 3 mg) as B0, B1, B2, B3, L0, L1, L2, L3, R0, R1,R2 and R3. In postoperative period, when the sensory block level decreased to T10level, loading dose of morphine or saline in 10 ml of volume were given epidurally.Parturients were then allowed to use a patient-controlled analgesia (PCA) devicegiving boluses of bupivacaine (20 mg), or levobupivacaine (20 mg) or ropivacaine (30mg) with 15 minutes lockout period. Sensory and motor blockade, scores for pain(VRS), sedation, patient comfort, the haemodynamic parameters and side effects wererecorded at 1, 2, 6, 12 and 24 hours after the start of PCA administration.On evaluated study groups, in the three main groups, (B, L and R groups), asthe dose of morphine increased, the dose of local anaesthetics decreased (p<0,001).Following epidural saline, patient controlled local anaesthetic consumption wassignificantly lower in levobupivacaine groups than in bupivacaine and ropivacainegroups (p<0,05). Local anaesthetic consumptions were significantly lower after 3 mgmorphine doses in B, L and R groups than after salin, 1 mg or 2 mg morphine in B, Land R. It was also significantly lower after 3 mg morphine loading in L groups whencompared with B and R groups(p<0,05). There was no significant difference betweengroups in sensory and motor blockade, pain (VRS) and sedation scores and sideeffects after the start of PCA administration.Three mg of epidural morphine for postcesarean pain relief was assumed to bepreferred because of longest duration of sensory block and lowest local anaestheticrequirement without causing significant side effect. If pure epidural local anaestheticswill used for postoperative pain relief, levobupivacaine should be preferred overbupivacaine or ropivacaine because of lower local anaesthetic consumption.Key words: Combined spinal epidural block, epidural patient controlled analgesia,levobupivacaine, bupivacaine ropivacaine morphine.VII